090182_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

type of Visit: (t:)oCompliance Inspection U Operation Keview U Structure Evaluation U Technical Assistance
Reason for Visit: ("outine Q Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: o s Arrival Time: Departure Time: t v County: tjjJeA,
Farm Name: Owner Email:
Owner Name: tft°jl/`t� "S test. F2�_V-lh LL C- Phone:
Mailing Address:
Physical Address:
Facility Contact- C&.g jl'5 (� zZvlk)& [ • Title:
Onsite Representative: l
Certified Operator: KGK E-a,s o-\-
Sack -up Operator:
Location of Farm:
Phone:
Region: L { �
Integrator: (48 — S
Certification Number: 7 &S 7-3
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
I
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
I Layer Dairy Cow
jNon-Layer I Dairy Calf
Current
Pap.
Wean to Feeder1
Feeder to Finish
DTsi
D . P,oul Ca aci P,o
ILayers
Nan -La ers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
113eef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
I lBeef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes U-NT--El NA ❑ NE
[:]Yes [::]No B-NA ❑ NE
[:]Yes [—]No NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑.-No
❑ NA
❑ NE
[:]Yes
[
❑ NA
❑ NE
Page I of 3 21412015 Continued

lFacility Number: jDate of Inspection: 13r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[]'1qX
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Erfqo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
i__1 Iqo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
a-N-o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
3-go
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [;J� ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑']moo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0--Iq-o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]Ilo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El -No
DNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M-lgo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[9"lo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2a o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[E'1Qo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[!J No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Z jDate of Inspection: 3 tJ
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [j-Nu ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E io
❑ NA
❑ NE
❑ Yes
D Ko-
❑ NA
❑ NE
[—]Yes Q 6 ❑ NA ❑ NE
[:]Yes LSD <o ❑ NA ❑ NE
[:]Yes ®moo ❑ NA ❑ NE
[:]Yes ffNo ❑ NA ❑ NE
❑ Yes
allo
❑ Yes
[]- -Ro
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
comments {refer to gneshon #)� ExpiauiiauyYES answers -and/or aRy additional recornmendatonstor`anyottier�comments.' R°
-v air --'+�z��r`-�.?1
Jse, droyingsrof,,facelity to; better explarntsiivahon_sa(use,addihonal pa as necessary,)y
_
C--L(( %- 3 09.6 t.s (
Reviewer/Inspector Name:
Reviewer/inspector Signa
Page 3 of 3
Phone: V -J33
tore: ` Date: 1,3
21412015

(Type of Visit: (D-Oompliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: 0-1toutine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: A ivaI Tiz ba Departure Time: a0 County: Region: i { 20
Farm Name: At 1-rk L e, Owner Email:
Owner Name: _ ki`r_& �� 't'h Phone:
Mailing Address:
Physical Address:
Facility Contact: .0"" CV iCr✓ Title: Phone:
Onsite Representative: �(. a Integrator: t413!g-
Certified Operator: _CyL�✓o4CC ��so•-� Certification Number: 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Desig4 Current
Wet Poultry Capacity 'Pop:
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
T77a
Non -La er I
Design
D . P,onl Ca aci
La ers
Current
P,o
Dairy Calf
Feeder to Finish
Farrow to Wean
Daia Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Noril ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
Turke s
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D-NV-_❑ NA ❑ NE
❑ Yes ❑ No &A ❑ NE
❑ Yes ❑ No [CIA ❑ NE
❑ Yes ❑ No
[:]Yes [a -No
❑ Yes D O
Q NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili (slumber: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[!J-4*fe—❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[Ej I
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E317To
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
H<
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ETNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q_ln
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
D-Iqo-
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EB- io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or W lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L
13. Soil Type(s): t j,9L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3'RIo ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes r.'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
©-ro
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Li< �o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
M o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
��w
es record keeping n7edtrovement? If yes, check the appropriate box bolo 'es No ❑ NA ❑ NE
2.� Lt
to Application kly�Freebo d ❑ Waste Analysis Soil Analysis ante Transfers ❑ Weather Code
J cc
Rainfall ❑Stocking Crop Yield120 Minute Inspections ❑Monthly and I" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d "'o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [jNo ❑ NA ❑ NE
Paige 2 of 3 21412015 Continued

Facili Number: Cy- Date of Inspection: G
24. Did the facility fail to calibrate waste application equipment as required by the permit? Iq es IT 40 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Kivu ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes Q-<o ❑ NA ❑ NE
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes [2-<o ❑ NA ❑ NE.
❑ Yes Io ❑ NA ❑ NE
❑ Yes [')Go ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes 19_ �o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [3'14o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ <o
ecessary).
0 141—L
et
f �r
si
Reviewer/Inspector Name:
Reviewer/inspector Signatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
C V"q ;IV�"4�
Phone4l(uAZ 3 -3
Date: l
21412015

Type of Visit: QTomphance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ("outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1- Departure Time: County: L
Farm Name: g2v�C�eCevt YyU�� Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: 1-6, 4w Title: Phone:
Onsite Representative: Integrator:
Certified Operator: � S &C. Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
III
Design C►urgent
Swine Capacity Pap.
Wean to Finish
.:1;; .., Design Current
Wet Poultrwa
y Capacity Pop,
Design Current
Cattle Capacity Pop.
Dai Cow
La er
Non -La er
Wean to Feeder
Sa—
3
Dai Calf
Feeder to Finish
Farrow to Wean
"'
Design Current
Dry P,oul yCa aci P`o P.
Dai Heifer
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes O�No ❑ NA ❑ NE
❑ Yes
❑ No
[t A
[] NE
[—]Yes
❑ No
[g-NA
❑ NE
❑ Yes ❑ No
❑ Yes Q-No
[:]Yes [a.No
glCTA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilitj Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-Nv--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3-NA—_❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c3 S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El - o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
I J No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3No
D NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes El"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): 13 cr/ tnI u.06R S (2-31 F
0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qr<o ❑ NA ❑ NE
I. Does the receiving crop and/or land application site need improvement? ❑ Yes [3No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable es [Vivo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
ff'No
[] NA
❑ NE
❑ Yes
[E]No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P3*'�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[:]Yes
�o
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists [:]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
0"No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
RNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
21. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RT<o [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E� "'o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ld O
❑ Yes [;IIqo
❑ Yes ❑'I o
❑NA ❑NE
❑ NA [] NE
❑ NA ❑ NE
❑ Yes E f No ❑ NA ❑ NE
[:]Yes [?io ❑ NA ❑ NE
[:]Yes E5'-No ❑ NA ❑ NE
❑ Yes [�No
❑ Yes Z No
❑ Yes dNo
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: Lu�� U %.A C.11 Phone: 3 3- 33 3
Reviewer/Inspector Signature:. Date: 5
Page 3 of 3 21412015

61 P1,5 a? L)ec, [s Q
Type of Visit: _ UCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (f routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Ltd County: 4e_k Region:
Farm Name: rce f-tA_ (,.,C- Owner Email:
Owner Name: N1`[,k G—o,, �ee Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Ka C4-\ Title: Phone: `
Onsite Representative: � Integrator: r� ] V
Certified Operator: Jv ` Cpc� o A Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current
Capacity Pop.
s 2
Wet Poultry
La er
Non -La er
D , P,oulte,
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Design
Capacity
Design
Ca aci
Current
Pap.
""
"Current
,.• Po ;
Design Current
Cattle Capacity Pop.
Da Cow
D ' Calf
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gaIlons)?
❑ Yes [3'1 i� ❑ NA ❑ NE
❑ Yes
[:]No
[VIVA
❑ NE
[:]Yes
[3 No
[J NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No [3 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EjNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: jDate of Ins ection:
`Waste Collection & Treatment
<o
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
L_d'KA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):g` —
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�0
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[2 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
[2,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZNo
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[JoNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes do ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window e❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):2J*LL
13. Soil Type(s): t�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2'96 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EI No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [:k<o [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:1<
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
io
❑ NA
❑ NE
the appropriate box.
❑ WiJP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes [2'&o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ErNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

lFacility Number: 11 jDate of Inspection:
24:,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [90 o [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E3,<
❑ NA
❑ NE
❑ Yes
LJ>a
❑ NA
❑ NE
[:]Yes
E2.n<o
❑ NA
❑ NE
[:]Yes [ <o ❑ NA ❑ NE
❑ Yes [ <o ❑ NA ❑ NE
❑ Yes [315o ❑ NA ❑ NE
[:]Yes
❑moo
❑ NA
❑ NE
D Yes
[3`�o
❑ NA
❑ NE
[:]Yes
Vo
❑ NA
❑ NE
Comments (refer to.question #):.Explain any YES answersandlor�anyadditional recommendations ors anyother�cotiamenEWE
�rt Mz -
Use drawings of 'facility to better explain situations:_(use ad.dtho 'pages -as necessary). - ,�}, ,.2
— Se,4t A°t5P
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
b _ 3.1 IP r �Z, 3
Phone: 1\j 3 33a
Date: 6 DU<
21412014

R1 h%j
i ype oI visit: LyGompuance inspection V operation xeview V structure Evaluation U i ecrinical Assistance
Reason for Visit: �utine GComplaint O Follow-up Q Referral 0 Emergency C) Other Q Denied Access
Date of Visit: Arrival Time:
+ Departure Time:EFEEy!] County: �k
Farm Name: _ Y Le, r&%rA,' Owner Email:
Owner Name: l/vlU1 A,,. .r"y,_ Phone:
Mailing Address:
Physical Address:
Facility Contact: K 15 Title: Phone:
Onsite Representative: k(3 Integrator: W (3
Certified Operator: on r c rj l/�'� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:{
Design Current
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity
Pop.
Wean to Finish I
ILayer
N o n -;L ajyer
Dairy Cow
Dairy Calf
Wean to Feeder
600
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Eurrent
Cow
Farrow to Feeder
D , P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes MNo— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No [2-M ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) 0 Yes 0 No E14Z� ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [) No [ � NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes 1Vo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [344A_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[i] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[!50'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E:f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �G1Wvia1 S C, -.7,>
13. Soil Type(s): p✓` Ce -L' qlS� +7O
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[� N
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
To
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[je o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
[�i No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Oct- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �3Go
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes [5No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [5"No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other-
3 2. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
se drawhids of facility to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V [LI
as
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes FR<o ❑ NA ❑ NE
❑ Yes C3 N ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes E2rNo
❑ Yes Rf No
❑ Yes [D]No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Phone: '[ -3 3 3
Date: v J. J � 1
21412014

w� Y U
. � a. �.� �-_� "� a rvtston aflWateiSQuaLty � ,�ffla�
s0 Other A enc
Type of Visit: 0<16mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
id All
Date of Visit: Arrival Time: Departure Time. County: &Lvi
Farm Name: W CCJUat L Owner Email:
Owner Name: Phone:
Mailing Address:
Region
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: AJr, 4{ Integrator: 1m R 7 !
Certified Operator: K.", �0(<0K _ _ Certification Number:���
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
i
Design�C rent'
�l I Des' Current- Design
Current
Si
wine Capacity Pop ::
Wet Poultry CaQacity : Cattle Capacity
Pop.
pPop°
Wean to Finish
La er DairyCow
Non -La er DairyCalf
J!
DairyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
De siguirreut D Cow
D Po_uit . Capaccl !Po Non -Dairy
La ers Beef Stocker
Farrow to Finish
=
Gilts
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Boars
*� r
Turke s
t?ther nk
Turkey Poults
Other .
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ENo ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [44A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [—]Yes ❑ No DkA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [—]Yes [] No A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [; No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 4o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a..Pd'o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? [:]Yes Wlo [DNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [J .No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ ,Ko ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes F;lXo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) '
9. Does any part of the waste management system other than the waste structures, require ❑ Yes G�Xo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes [± No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes L No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s).
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[J o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E!rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Wo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[IfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[g No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
h10
❑ NA
_ ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. [:]Yes [V�'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [J No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F9"No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to alibrate waste application equipment as required by the permit? ❑ Yes KI"No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑r '<o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
QJNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[]I.Alo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[[�Wo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L.tLXo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U�o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[4<
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
-,..
Comments (refer, to _question #I): Explain any YES answers and/ar.any additional recommendations or: anyiother�commeats.
Use drawings of facility to better explain situations (use additional pagesas necessary).
:a
oC"z 1 `�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Photi'b:V ~ 1J6-7�33I
Date: ft Ni 11
21412011

IF,ac_ilily"LNiimber -I
Type of Visit: Q'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: eRoutine Q Complaint Q Follow-up O Referral Q Emergency O Other 0 Denied Access
Date of Visit: I
Arrival Time: � OU
Departure Time: da
County: Region:
Farm Name: j` j ;G�
��/` �u �M'
Owner Email:
Owner Name: jj, h Q o4C-00� t I— Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: r 76) - 41 Phone:
Onsite Representative: Integrator: AV r
Certified Operator: G k, a -._. Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. WeIMMU11tra city Pap.
� .
C►attle Capacity Pop.
Wean to Finish La er
Dairy Cow
D2'g Calf
Wean to Feeder
-Layer
Feeder to Finish
Da' er Heif
Farrow to Wean
Farrow to Feeder
Design
D , P.ownkla aci
Current
P,o ,
Cow
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
113eef Brood Cow
Turke s
QWer Turke Pouets
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance mars -made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
R No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit . ,Number: T - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[g No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in): --��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
K No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ej No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (a No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6,,, ,t ,),
13. Soil Type(s): C
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
®. No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q_No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of inspection: ff
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes n No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [y No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®,No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes Pq No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
rV; No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
F21 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(A No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
GjNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES=answers' and/or any additional reeommendati_ons orany other comments'°
Use drawings.of facility to better explain situations (useadditional pages as necessary)." K`a�;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: ��116 ��-
2/4/2011
Page 3 of 3

Type of Visit: �,ommppliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: f7 xoutine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Z' —JM Arrival Time: Departure Time: A County:
Farm Name: A r_k rvt- ��''iKS G LC Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: oar Title:
Onsite Representative: .jars
Certified Operator: �[ �H �r,G% ,was �-.�✓
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: F/ [,
Integrator: r
Certification Number:
Certification Number:
Longitude:
"' Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet P°r�* ity Pop.
Cattle- Capacity Pop.
Wean to Finish
La er
Dai Cow
Dai Calf
Wean to Feeder
Non -La er
Feeder to Finish
" T;.:p'
Dai Heifer
Farrow to Wean
�„ -
D Poiil '
La ers
on -Layers
IPullets
Design Current
Ca' city l;o ,
Dry Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
Beef Brood Co —
Turkeys
Other
Turkey Puults
Other
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[] Yes ® No [:a NA ❑ NE
[—]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 1 of 3
21412011 Continued

[Facility Number: - Date of inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E@ No ❑ NA ❑ NE
t
a. If yes, is waste level into the structural freeboard? ❑ Yes RNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[-]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
&] No
'�i
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 5allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window ❑ Evidence
of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): L 4F
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ,Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CE[ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [',�,21..No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

I�
Facili Number: Dainspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Y, No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1�21 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Dg No ❑ NA ❑ NE
❑ Yes fA No ❑ NA ❑ NE
❑ Yes JS No ❑ NA ❑ NE
❑ Yes CK No
❑ Yes No
[—]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or.,any additional recommendations•or any other commence
Use drawings of facility t©'better explain situations (use additional Wages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
r
Date: r`v
21412011

Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Gel routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Ih/a Arrival Time: Departure Time: l7: C? County: Region:
Farm Name: /`� / II--sa��at7 r u - Owner Email:
Owner Name: _ /�/[_Grr�5 Phone:
Mailing Address:
Physical Address:
Facility Contact: 1�i`7r� Title:
Onsite Representative: Lr—
Certified Operator:
Back-up Operator:
Phone No:
Integrator: Ay —
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= e = t 0 Longitude: = o =1 = "
Design G+�urrent
Design Current
Design Current
Swine Capacity Population
wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
I
I
❑ Dairy Cow
❑ Dairy Calf
Wean to Feeder
❑ Non -Layer
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Co
❑ Turke s
Other
❑ Other
❑Turke Poults
❑
Number of Structures:
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes B o ❑ NA ❑ NE
❑ Yes
❑ No
93 NA
❑ NE
❑ Yes
❑ No
9NA
❑ NE
❑ Yes
❑ o
�(NA
❑ NE
❑ Yes
❑ NA
[3NE
El Yes
Zo
❑NA
El NE
Page I of 3 12128104 Continued

Facility Number: —A= Date of Inspection /
Waste Collection & Treatment '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑ NA . ❑ NE
Structu�e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: fyl)
Designed Freeboard (in): _ _ /C7
Observed Freeboard (in): '�5Z
❑ Yes R IVo
❑ Yes Q N
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[] 1<
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
3 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P,<o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[91�o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
E3<o
❑ NA
❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 04o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE i
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
I
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,—,[�10 [I NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [io ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes Q/No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a tack of properly operating waste application equipment?
L �iiY1 dz A,Ic•� _ -& w --A- H^ �Gt GS
Lcars ?hZ"...G�
44--1 "' � c
P� �
Reviewer/Inspector Name
Reviewer/Inspector Sioiai
❑ Yes Q o ❑ NA
❑ Yes 93 o ❑ NA
-� y T . -
�v �67
Phone: 111/0 —'f.33
Date: // A.,i %v
❑ NE
❑ NE
Page 2 of 3
12128104 Continued

lRaciiity Number: 4 Date of Inspection %7
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L�'oo El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box. - ❑ WLJP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ETNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ff No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
El No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L33No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �YNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[jNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
UNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�,/
Ltd No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
GJA<o
❑ NA
❑ NE
Page 3 of 3 12128104

3TK-4-s 10-04-z009
+elivision of Water Quality
Facility Number p (7 O Division of Soil and Water Conservation
--- 0 Other Agency
Type of Visit (2r;Routine
mp . nce Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: %�3%1—� Arrival Time: ' Departure Time: f7�.��C7 County:«''� '� Region: Aloz
Farm Name: r Cii/ Owner Email:
Owner Name: r L & 60o of 4 Phone:
Mailing Address:
Physical Address:
Facility Contact: , 444 ,, D'ju�Lt� Title: / �4+e� ,! Phone No:
Onsite Representative: / ,lH �tl�-,��✓ Integrator: /Vu✓D/Gy%a��
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: = o = 1 ="
Longitude: = o = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Non-Layet
Other
❑ Other }.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Cattle
Design Current
Capacity Population
i,.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
a
=1
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No ;"NOA ❑ NE
❑ Yes NA El NE
❑ Yes�N�oEOI NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: /v0
Designed Freeboard (in): / 9
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �,
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes CK ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No El NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes O<o LJ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 ibs El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi Wit❑ Application Outside of Area
12. Crop type(s) _ GY/uu � �v l m!:�� G rujNA,S.)
13. Soil type(s) Olt,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes d_ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes No NA ❑ NE
17. Does the facility lack pp adeq uate acreage for land application? ❑ Yes :0--10:11
oNA Cl NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name HI— I e-ve, S Phone: 333tV
Reviewer/Inspector Signature: Date: 7 —J'%
12128104 Continued

Facility Number: Q — 9,;7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NoNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L1 No ❑ NA ❑ NE
the appropiiate box
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Zo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain InspectionsEl Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes:��oONA
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as re required b the permit?
pPq Y p
❑ Yes
❑ NE
25.
Didthe facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o ❑ NA
:�`o
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PKo ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NA
El
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes:�o/OEINA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No ❑ NA
❑ NE
31.
If yes, contact a regional Air Quality representative immediately
Did facility fail
,.,
the to notify the regional office of emergency situations as required by
❑ Yes
a<o NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo❑ NA
❑ NE
Addifianal+Comments: and/or Drawings
�.
Page 3 of 3 12128104

(ZtSe Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit autine Q Complaint Q Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: r} Arrival Time: Departure Time: =County:
Farm Name: �N G / 64— ratr"I // Owner Email:
Owner Name: C'''L Fa ✓ 1 k % / G Phone:
Mailing Address:
Physical Address:
Facility Contact: Lf !!-% 1r, Title:
Onsite Representative: /
Certified Operator: /t�rto� li C kQ
Back-up Operator:
Region: Lev
Phone No:
Integrator: dr
Operator Certification Number:�s�3�
Back-up Certification Number:
Location of Farm: Latitude: 00 [= i [= Longitude: 00 = g [= U
Design
Current Design
Current Design Current
Swine Capacity
Population .Wet poultry r Capacity
❑ Layer
❑Non -La er
-
D�Poultry�
Papulafian a Capacity Population
❑ Wean to Finish
❑Dai Cow
Wean to Feeder
❑Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
rrow to Feeder
-
❑ Non -Dairy
rrow to Finish
❑ Beef Stocker
lts
❑ Beef Feeder
❑ Beef Brood Coher
6EH] ars
Number of Structures:ED
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1 Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(A No
❑ NA
❑ NE
[-]Yes
MNa
❑ NA
❑ NE
Page I of 3 11/18/04 Continued
lTypeofVisit

' Facility Number: —/ Date of Inspection
` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [--]Yes KNo ❑ NA. ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? JZLYes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks.. or compliance alternatives that need ❑ Yes tZ No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground JR Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) +y2�rn
13. Soil type(s) C zo
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CKNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J9No ❑ NA ❑ NE
W Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 21 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes E[No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes N No ❑ NA ❑ NE
Comments re%'r to question #}. Explain any YES answers and/or, anvyrecommendations or any other comments r"
Use drawtngs;of facility to.better explain situations. (use additional pages as taecessary) '
have rna e ice r- J,�&j rcc►dl p2 5 m a tr rz-«�� i
e-PL- a I r! � ep�ve-sr jo0D ,rry P % L Tr'.55r-
Reviewcrllnspector Name i✓ � �' I Phone: 17 n'- 33-33 DO
Reviewer/inspector Signature: Date: " '
Pooro 7 of 3 17/29/64 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 91 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
f0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
59 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
fia No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
��yyyy
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J.No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality V
Facility Number 0 Division of Soil and Water Conservation _
0 Other Agency'
IType of Visit Cr-Compliance Inspection O Operation Review () Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �-D Arrival Time: Departure Time: , County: 414aofQl Region: (. U
Farm Name: Iz ; r ,A/ ��-Q►rm �- G Owner Email:
Owner Name: IAI; Ct.-K LG L Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: A,, r' iC
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
�o
Latitude:
Phone No:
Integrator: /
Operator Certification Number:
Back-up Certification Number:
="
Longitude: = ° =' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
3� ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population -.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
C!Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 4No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection D
r -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[9,No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CKNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CK No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dri1i ❑ Application Outside of Area
12. Crop type(s) rr
13. Soil type(s) 0�w
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
®,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ENo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
-rdk Y-0 177AP v r Qig �Ci! may- ,( •
Reviewer/inspector Name Phone:%Q 3 —37O
Reviewer/Inspector Signature: Date:
6/L0/V4 t untinuvu

Facility Number: — Date of Inspection :O
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ERNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. KYes ❑ No ❑ NA ❑ NE
❑ Waste Application 54 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ER No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5g No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LRNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
Cl NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CKNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
12128104

0
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit erkoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: rrival Time: TO 6 Departure Time: County: Region: X a
Farm Name: L_G ��.ti f R r)*l S �C- Owner Email:
Owner Name: ._.. f G k e. S ._ _jSe ✓_ ►"_5 Phone:
Mailing Address:
Physical Address: /
Facility Contact: �� G, ` t��SfJOr Title:
Onsite Representative: `
Certified Operator: f G
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: 4&A'z
or
Operator Certification Number:
Back-up Certification Number:
Latitude: a o 0 A Longitude: 0 0= 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3SS ❑ Non -La et
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ 7 urkey Poults
❑ Other
DischaMes & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design -Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
10 No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
12128104 Continued

Facility Number: —� Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JO No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ 1 9
Observed Freeboard (in): _`3 67
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
JO No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
5Q No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
YX No
ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R) No
❑ NA ❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) XD ✓r
13. Soil type(s) G P
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
f $No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
&No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,KLNo
❑ NA ❑ NE
Reviewer/Inspector Name tq, Phone: 3 -�33A0
Reviewer/inspector Signature: Date: —'�700
12128104 Condnned

1Facility Number: g — Date of Inspection �6
is
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check XYes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists EADesign ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 29 120 Minute Inspections JS Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25_ Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
$.Yes
❑ No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
[]Yes ERNo ❑ NA ❑ NE
❑ Yes IM No ❑ NA ❑ NE
[--]Yes 91 No ❑ NA ❑ NE
❑ Yes
fR No
❑ NA
❑ NE
❑ Yes
CK No
❑ NA
❑ NE
Additional, Comments and/or Drawings:
J
v2 `f JJ�r"o�s Cad rcz`�a'"`- ©�-�/'�'�a-7� �'"' � �-u�'m�..�•
w
Page 3 of 3 12128104

Type of Visit Q0 ompliance Inspection O.Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: � � Departure Time: I� � County: C(11,�^ Region: ��
Farm Name: Owner Email:
Owner Name: _ Vi2zUd S Phone: /
Mailing Address: zc3 y
Physical Address:,/%l,r
Facility Contact: ��r �i f7 —z Title: Phone No: ,:!5­31
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = n = I =1 11
Longitude: = ° = I =
- j7
D, .Current
Desrgn 4Current
Design Current
Swine
Ca aci Population
PN_
Wet Poultry
Capacity Popnlatrori
mom-
Cattle Capacity Population
❑ Wean to Finish
1 10 Layer
❑Dai Cow
[f"Wean to Feeder
Z70p
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
_ =
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
r ""``
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
ers
❑Beef Feeder
❑ Boars
CNa
❑ Beef Brood Cother
�' a
oultser
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
allo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
WLNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[A No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®.No
❑ NA
❑ NE
other than from a discharge'?
12128104
Condnaed

Facility Number: — Date of Inspectional
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes MNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis C&Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking §4Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0o
D .NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(& No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
5�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ER No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
R No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q�No
❑ NA
❑ NE
)P06-rdrap y; r rf� maµ rt c f 1prr w o r
y has .ate Y.� /fa��rSfi�Gl Sr��G ter.in.�s
�—V'q'\ evr-�Gry •�^�. }iri�,��-r fC�r� r`�ac ar� �d� crop�f�
.ZA/ r Thaw Npr� a.Q
,/4u I{/rrr► � L-�m ,c CCs v1'o }� ��6 �,� C�c �l �r,
1228104

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): X9
Observed Freeboard (in):<�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes f4 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No El NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
X No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
F9 No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
{,MtNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
10. aw! A,-e 4t v-a c-� L Q� oa da,,ks
Reviewer/Inspector Name '-" :,a " ,r 9 Phone: 7��y/ - �JC
Reviewer/Inspector Signature: Date: .2 J
12121W conunuea

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O tither ❑ Denied Access
Facility Number Date of Visit: lZI 3 �O�f Tune: /: o0
Q Not Operational O Below Threshold
91 Permitted 61 Certified © Conditionally Certified 13 Registered Date -Last Operated or Above Threshold:
Farm Name: �-� goo �� `^�' County:
Owner Name: S - -• Phone No: ....,A0 11
N�C,L�+� �
� . a-rL�-,..� 8 �t
2
i1�Iaihng Address....,,..•,��..$�._..... .._�. » -- — � ..._..�._....._ - - - - - •--•-•-- _...........�..�
Facility Contact: e-- 5�4�nC-Tit1e:......... ... Phone No:
a
Onsite Representative: - . ..b � - S� ��rK. . Integrator-. tetra j� S
Certified Operator. � �:t-S s Operator Certification Number. '? 9 52 IS -
Location of Farm: 5 &x-0 % ?$ 57--�- if
..
1ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �` Du
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PkNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes MNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier: _ _ -- ..._.... ..
❑ Spillway ❑ Yes 2k4o
Structure 4 Structure 5 Structure 5
Freeboard (inches): 1
12112103 Continued

Facility Number: R — r8 Date of Inspection 1 1
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public Health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes P1 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Wo
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes 6No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type a a ro0.g 5 - G rVL 7 ej . Swta.`L at rrx� h - e i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes jkNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes 9No
c) This facility is pended for a wettable acre determination? ❑ Yes C&No
15. Does the receiving crop need improvement? ❑ Yes Flo
16. Is there a lack of adequate waste application equipment? ❑ Yes JKNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 21 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes J!�No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes &` No
Air Quality representative immediately.
Se, C.�0d.o, A4+ ,r - Stet' 2 ZS (1, PA is /ac.
CIsw. w oc* - µ.r So 16 PA,0 l
Reviewer/Inspector Name `;,;
❑ Final Notes
Reviewer/Inspector Signature:
12112103
Date:
Continued

Facility Number: q _ 18 Date of Inspection I2
•Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
K No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
'etc.)
❑ Yes
(ie/ WUP:checklistV,"design, maW,
Wo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
J29 No
❑ Waste Applicatick/O FreeboariY/❑ Waste AnalysiL"'❑ Soil Sampling/
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2KNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
O-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
C&No
27. Did Reviewer/Inspector fail to discuss reviewrnspection with on -site representative?
❑ Yes
0,No
28. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ULNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
VJNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ RainfAK ❑ Inspection After 1 " Rain a -
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
1. (p TTk&j-e. 7 S awe o tL -q- wa.S�c SAA&*r_ 0-1,.-
Z . Li ,..t a PC s v. -OAC-e 60-"t-
'�fw►-S �a�� acccrr+-cJ o�f�L�e:r lo�ztloi
o � (orS(6`t LY�:s.
wtake. _t14P
12112103

'J
Facility Number Q Date of Visit: ime: i =
rO Not Operational 0 Below Threshold
13 Permitted [3 CCertified13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: C r6 o ked D r� c,1_ ++� County: ZVC_ e�__
Owner Name: �b�►►t G1`- �+� /�-- Phone No: S3`C�� Jr3
Mailing Address: a /�- _. /a al_CJ r7' O AIC—
Facility Contact: �� j'�-'a'r� Title: Phone No:
Onsite Representative:
Certified Operator: 719 elv�, `^ __ �ei,..lr•�
Location of Farm:
Integrator
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' ` 0 u Longitude =a `
Wean to Feeder
Feeder to Finish
Farrow to Feeder
Farrow to Finish
uid Waste
Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes J No
c. If discharge is observed, what is the estimated flow in gal/min? "�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes rNc,
o2. is there evidence of past discharge from any part of the operation? ElYes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R11110
Waste Collection & Treatment `
4. is storage capacity (freeboard plus stone storage) less than adequate? El Spillway ❑ Yes `f� NN_Q
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 0 7 —
Date of Inspection r0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type oe/'Pop LL0(Lq^ f- Zep{
13. Do the receiving crops differ with those designated in the (rti
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
de -
Animal Waste Management Plan (CAWMP)?
16. is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, EianalysAsoil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 4 No
❑ Yes No
❑ Yes gl No
❑ Yes rO No
❑ Yes gNo
❑ Yes KNo
❑ Yes No
❑ Yes No
ElYesIN
No
❑ YesNo
El YesNo
El Yeso
❑ Yes f>(No
❑ Yes VNo
❑ Yes
XYes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
o
N
No
WO
fiqNo
No
No
No
No
plia-
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
..,
Comwnents{refer to question #} E>nilaie any YES an wers'andlor any recommendations or any, other. eommeats '' ok
3 - H y'r,ii _ - r _
Use drawings of facility to'better exphtmsetuabons {useddttional
pages as necessary). ❑ Field Copy ❑ Final Notes
�0?1 AJeect IV V p(A 4O4.S 501--p des More -
ark`
—
Reviewer/Ins ector Name
Reviewer/Inspector Signature: Date: 70
05103101 Continued

F�,
Facility Number: — Date of Inspection
QS Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Ayes ❑ No
❑ Yes No
El Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
05103101

t�;Drvrsran of Water_Quahty
_T Q. Ihvisaon of Soil and'
Conservation =77
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit @ Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:
/� D Time: /O ;.�D Printed on: 7/21/2000
Q Not Operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified ❑ Registered
Date Last Operated or Above Threshold: .........................
Farm Name /1 ................
County. .......................
Owner Name:.............. . ...5�1. �/ .................................................
Phone No:......1 (���... ............. -...•_._ SZ4 ...........
FacilityContact: ........ 7 .:t ......r............ Title: ........................ ............................ Phone No:.........__------_..------.........................
Mailing Address: '5 0..1� �,w,✓ //��.�w r �.e� /G .Z�3�z.........................
.............................. ..........................I. .../...... ............ ../...° ...................%j..._.................................
Onsite Representative:_ c� •-� wa3/�/
.............................._........_....
Integrator:...... •�or. �-r....................
Certified Operator: .......... 7' ............... �� s✓N,••,•,•
„ Operator Certification Number:
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �46 Longitude �' �� �44
'Design,. Current Design Current Design Current _
S,.gvine ry � _
ci `..Po uliation Poultry Ca ci Po ulation Cattle P lion .
Wean to Feeder 4 fZ ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non Layer 10 Non -Dairy
Farrow to Wean
_ Farrow to Feeder a ❑ Other
Farrow to Finish Total Dedgn Cad
Giltsty
`-` Boars Total SSLW
N ffi - W Subsurface Drains Present I.ag+wur Area 0 Spray Field Area
_ Lagoa
Pow l SoSd=T No Liquid Waste Management System
S` _ 4 Y
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes � No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes CR-No
b. If discharge is observed. did it reach Water of the State'? (if yes, notify DWQ) ❑Yes CRNo
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes W No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 5•No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes IfNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........�_
Freeboard (inches):
5100 Continued on back

Facility Number: — �Z Date of Inspection ��� Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes {S�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes �MNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes PQ"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes allo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [�j No
12. Crop type �k
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ['No
b) Does the facility need a wettable acre determination? ❑ Yes CR•No
c) This facility is pended for a wettable acre determination? ❑ Yes .® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) `�
19. Does recoid keeping need improvement? (ie/ irrigation, freeboard, ast�anal & sail sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
..........
yiola�igFjs;or deficiendej were pofed•d. iWirtg this -visit:- V6 *j11-reb6*ci do further -; .
eoriesoorideike-' abirtit: this visit.
menu (rcler#o gnestion #) ;.lExplaiii'any-YF5 attsiwers and/or any recommendations or.anyother comntents
Irawtngs,'of fac>l>ty to;better eaiplatq$ituatioas (use;additionai pages as,necessary)'
❑ Yes IqNo
❑ Yes KNo
❑ Yes allo
❑ Yes Kallo
gYes QNo
❑ Yes KNo
❑ Yes P121
0
❑ Yes _j No
❑ Yes 5a No
❑ Yes RNo
❑ Yes CJ�No
A,
Reviewer/Ins 1?� for Name = ' -S
_'_.....
Reviewer/Inspector Signature: / ,� Date: �� dI 5100

I
Faeilhy Number: Q Date of Inspection: / 6 Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below )KYes m No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during Iand application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ($No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes R'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes RNo
31. Do the animals feed storage bins fail to have appropriate cover? 0 Yes iR No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes (K[No
5100

'S
® Division of Water Quality
Q Division of Soil and Water Conservation "
- - i
Q Other. Agency
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number p Z ,)ate of Visit: Time: Printed on: 7/2112000
Q Not operational Q Below Threshold
13 Permitted ® Certified 0 Conditionally Certified [] Registered Date Last Operated or Above Threshold: .....................
Farm Name .,,CAfl l�iF�cx^................................................ — County': ........... Z7/..............................................
Owner Name: �--y .J
' 1................/......... ���.5��........................................................ Phone No:.......�.........�r.�..........�.-,�.(•------......------...
FacilityContact : ........ �.........:.. ......... Titte................................................................ Phone No....................................................
Mailing Address:.........., ... /. G✓!��... / ..- .. f�fJ.......................................�........... ........................
On -site Representative: d �^ �. .. Integrator: ,/, f�,,,,-
.......... /
Certified Operator: .......... ±s (,rJ�(% ,- �......_. Operator Certification Number:.- .. �-O .Y 11
Location of Farm:
..
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �� Longitude C •
Design Current
Swine Capacity Ponulation
Wean to Feeder
fr2
3 Z
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry _ Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons / ❑ Subsurface Drains Present ❑ Lag,-,n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts•
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'.' ❑ Yes No
b. If discharge is observed, did it reach Water of the State'! (If yes, notify DWQ) El Yes (KNo
c. II' discharge is observed. what is the estimated Ilow in gal/min?
cf. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes JRLNo
2. Is there evidence of past discharge from any part of the operation? []Yes )K] No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ID No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'! ❑ Spillway ❑ Yes DR No
Sn-ueture; I Structure 2 Structure I Structure 4 Structure 5 Structure 6
Identifier: ''rr
_3c i ..............
Freeboard (inches):
5100 Continued on back

it
Facility Number: 9 — L Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? y ❑ Yes kNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes A No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )KNo
12. Crop type g",,
13. Do the receiving crops differ wit those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
e) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
17, Pail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NO-0 06fis;0- deficiencies were noted di>r ng xhis;visit: Yoi� will r&6*4y iio further; • ; • ;
corieporiden& atbout this :visit.... ....; ..:.:. . .....:.:.....:..... . ... . .:.:.:. ; . ; _ : _ . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes k No
❑ Yes NNo
❑ Yes )K No
❑ Yes ip No
❑ Yes ❑ No
❑ Yes X No
❑ Yes �X No
❑ Yes kNo
❑ Yes XNo
❑ Yes XNo
❑ Yes )�a No
❑ Yes �YNo
❑ Yes No
❑ Yes No
❑ Yes j] No
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 8 p T 5100

I -•
Facility Number: 09 —%!�Z Date of Inspection j Printed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aJor Mow
XYes
❑ No
liquid level of lagoon or storage pond with no agitation?
<<
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
PTNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
RNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
VNo
Additional:Comments and/orDrawings: _ _ -
Ak
5100

,.. +.. -a
Facility Number � � � Date of Inspection
Time of Inspection : ja 24 hr. (hh:mm)
Permitted 9(certified (3 Conditionally Certified [] Registered 113 Not Operational I Date t Operated:
Farm Name: �rs!l` Oav_eA.....F4r/Y1....._ County: ...........U.1.. ...................
Owner Name: p�%�i............................................. Phone No:............. /.IO 53I
.......... .......
... .....- - .. V .... I ...........
.
Facility Contact: .......... !3........�%i���tirS��'1..... Title: ................................................................ Phone No: .................................................
Mailing Address:. C�LLZA......:.. ......... ..........................
........ .......... ... ............. ...x�. .. a�3S�
Onsite Representative:......,,,...... / Yj,,, Inte rator• l S ,C-z,......
.............. ..... ................. g ldt/.!!D.................................�.............
Certified Operator:.,,..,,,.,. "...:... J ! -r'/� Operator [ ert�fication Number•,,.,,,,,.,,
.............................................. ,
Location of Farm:
r
...........................I............I................................................... ._ - .-..._..... .._................. .......
Latitude ' ° Longitude • & C "
.-Design
Current
Design Current_
Desigri" Current `
Swine . , '--Capacity
Population : :Poultry Ca acit .- ;Po ulation, , -Cattle ==
Capacity Po ulafson .
Wean to Feeder
35,
❑ Layer
❑Dairy
Feeder to Finish
❑ Non -Layer
_
❑ Non -Dairy
❑ Farrow to Wean
-
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Desi91 Cap --t-Y-
❑ Gilts,
❑ Boars
F -: _ _ . ;- Tota1-SSLW
z Number a _-Lagoons..-
,HoEcLngPonds / Solid.Traps
Discharges & Stream Impacts
Is any discharge observed from any part of the operation?
Subsurface Drains Present
No Liquid Waste Manigen
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
Lagoon Area i❑ Spray Field Area
System =
a, if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
ldentif`ier:
Freeboard(inches). ........... P.................... ...............................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes [XNo
❑ Yes [] No
❑ Yes [i No
❑ Yes rgNo
❑ Yes [f No
❑ Yes R No
[]Yes ANo
Structure 6
❑ Yes 9(No
Continued on back
3/23/99

r
Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of'the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified AnimaYWaste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
_1.
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
vRdati6rs:or• def cie'ndes -r'were h6fea- dWig this:vsit' • Yoir'ill •rceve fio furthr - - ::
correspondence. ahatuti this visits
❑ Yes XN o
❑ Yes ❑ No
❑ Yes XNo
❑ Yes [(No
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
[Yes ❑ No
❑`Yes (KNo
❑ Yes $0
❑ Yes INo
A
Yes El No
- 4
El Yes W No
❑ Yes {x No
❑ Yes JKNo
❑ Yes awNo
❑ Yes /> No
❑ Yes �No
Comments (refer to questionjW7. Explain any YES ansr�ers anid/or any recommendations or-_anyother comments �'
E -
Usedrawing of facility to, better ex lath s taatio �use�add�t,onal a es as necessa .
__ , :.. a „, - p s ti - - ry) - _
/= a"
/3.one awe > A, n
ir-
gas 4
HAP,
Reviewer/Inspector Name _ - 1
Reviewer/Inspector Signature: ,./10= _ Date:
3/23199

•. w
Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon`!
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
3i. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
1411+
❑ Yes K,o
ElYes XNO
❑ Yes 1 No
❑ Yes XN 0
❑ Yes [.No
El Yes XNo
❑ Yes ❑ No
Additional: Comments -and/or- rawrngs
61
3/23/99

n
[3 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
O Routine O Com laint Q Follow -up -of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection
4
Time of Inspection =,rd 24 hr. (hh:mm)
Registered 0 Certified 0 Applied for Permit 13 Permitted 0 Not O erattanal Date Last Operated:
Farm Name :-•i2op¢4dS.c.....t14��............................. County: ........... :i/`J..............................................
Owner Name: ......-.........
T-�-_.....1.........._..........................Phone No:
..
FacilftyContact: ......... Title: ................................... Phone No:...................................................
Mailing Address:......., ..... ,+ f '... �o�o +� 2 ._
:..... .. ........... .I.......%rSr...............f...�C'................................................r.......... f
Onsite Representative:......©� �I� g G
.. Irate star:.... �1 tii" .........
Certified Operator,....... . Operator Certification Number:---...1.VYL
Location of Farm:
Latitude • 4 C6 Longitude =' =` 0"
Ines Cnri`ent q'P r Deli ;Current° Des'Q�{� CuFrent
mob--.
�i"�-
"�" T➢ 'f.. w�
Swine k Ca acit `
`Y A.,� a .'F :mY `S41'b3� �N J -___
P ulation, P,aultry� 4' Capacity„"Population°Cattle CapaeityPopulstion
Wean to Feeder J"Z
Z4 ❑Layer I0 Dairy,^
❑ Feeder to Finish
, < ❑ Dion -Layer
❑ Non -Dairy
.£-
❑ Farrow to Wean
�? ❑ Other ZZ
❑Farrow to Feeder
;u
❑ Farrow to Finisha
tf Tofal Design Capacaty�k
�: y
a
�f tai 5 W,
To SL
❑ Gilts
❑Boars
w
$ S. `'„di'iw'.. x� « ,, ,ne im,`v;/ 'Mf'i� e.�F.u• .:.L fek
Nurnbersof Lagoons / Holduig Ponds ❑ Subsurface Drains Present ❑ Lagoon Area Spray Feld Area
..... ....
❑ No Liquid Waste Management Systems
',�,.iw',
f s�: ,3J '.'#. .;�'YJF +dui. J..i
, is _. Ems.. •t3'0...
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes O No
❑ Yes ONo
❑ Yes akNo
❑ Yes RNo
❑ Yes KNo
❑ Yes KNo
❑ Yes P'No
❑ Yes lRNo
❑ Yes P No
❑ Yes 7
Continued on back

l '1_
Facility Number: Of — Z
8. Are there lagoons or storage ponds on site which need to be properly closed?
El Yes
29 No
Structures, (Lagpons,tloldinp Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
RrNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:
Freeboard(ft): ..............1.9...............................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
El Yes
�No
12. Do any of the structures need maintenancelimprovement?
1%Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13, Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
IffNo
(If in excess of WL MP, or runoff entering waters of the State, notify DWQ)
15. Crop type f�,.A^,*�'e................................... .---....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
KNo
17. Does the facility have a lack of adequate icreage for land application?
❑ Yes
RNo
18. Does the receiving crop need improvement?
❑ Yes
No
19. is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
JK No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;9 No
22.
Does record keeping need improvement?
❑ Yes
No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified,AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0, No.violkions.or deficiencies were ntited;during this,Asi& Yodw'ill i&e' i've:no:fdrttier' -'
_ Oertspotideh6about this`visit:.: ;
AC
�cri�i�i��r✓
7/25/97
Reviewer/Inspector g — b� ' 51.
\aIr1C<� p' w a a. a
Reviewer/Inspectar Signature: Date:

...._.....
❑ DSWC Animal Feedlot Operation Review
e DWQ Anil Feedlot Operation Site Inspection
maeeeraon on
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Foilow-upof DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection //.'8D 24 hr. (hh:mm)
Registered [3 Certified 0 Applied for Permit Cl Permitted EI Not Operational Date Last Operated: ...
--..........
Farm name./ a••^ ,,��o%t ! ..f "�"`"" ....................... County:.......... -� ...................... ...
............. ..... ............. ................ .....
'Owner Name: ................�0'!"...... Phone No:..k./...�0 )......�1....`...T -3y
................ r.....%K�J..................................... ..
Facility Contact: ld..=1.
4 ,. Ziitle: ......................... one iVo:
Mailing Address:.......1..%..CL.Q....c�.J...... .. .. � �.f ................... ��.Z......... ....................... .. f... N G
OnsiteRepresentative :........ %+.. ... . s ld-t.,.?J....................................... Integrator ....... ).fi° ........t. .........,l .re .....
Certified Operator;.......1. ...y- .............f. . .....5..(i l Operator Certification Number;.../I y/. nfil
Location of Farm:
r�
C)
.............
.............................................. ... ..................................................................-............................ ....................................................................... ,...................
.. ............,/.................................. :.................................. -.-....... .................-............................ ........ ........... .......-............................................................................... �
Latitude Longitude �• �� ���
7.Design °' Current Design Current Design , Current . K
,Swine -'-Capacity- Population' Poultry Capacity. Popula#ion. Cattle- Capacity, Population
Wean to Feeder 3d-,5Z- I0 Layer ❑ Dairy
❑ Feeder to Finish JE1Non-Layer ❑ Non -Dairy
❑ Farrow to Wean r
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity :E--
❑ Gilts
❑ Boars Total SSLW '
Numbeie of Lagoons / Holding fonds;. ❑ Subsurface Drains Present ❑Lagoon Area 10Spray Field Area
❑ No Liquid Waste Management System 4 a
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes X1No
2. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes KNo
b. If discharge is observed, did it reach Surface Water'! (lf yca. notify DWQ) ❑ Yes El No
c. If discharge is observed, what is the estimated flow in g,tal/min?
d. Does discharge bypass a lagoon system'? (If ycs, notify DWQ) El Yes CR No
3. Is there evidence of past discharge from any part of the operation`! ❑ Yes 99 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes kNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes &No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes i9No
7/25197
Continued an back

Facility Number: &i — 372—
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaPoons.11olding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ............3.„ C2
................................. ............. - ....................
...
10. Is seepage observed from any of the structures'?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13- Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes W-No
❑ Yes "No
Structure 5 Structure 6
...............................................................
15. Crop type its ...............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
24. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Cerlified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations flr deficiencies rwere-noted during this:visit.-:You.will receive no ftirttier,
correspondence shoat this:visit:
❑ Yes W No
❑ Yes KNo
jKYes ❑ No
❑ Yes W No
❑ Yes M No
❑ Yes CO No
❑ Yes No
A Yes ❑ No
❑ Yes 13 No
❑ Yes I' No
❑ Yes ® No
X Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes No
C&im eats (refer t guestion #) ' Explain any YES answers and/or any recomb�endations;or any other cornfnents, ;
Use drawings of facility to•betier explata.sitttations {use additional pages as iiecessary} ;; �'
f. r •.
CORv � 14 'C�M'Tr° � e� !./.t�t� .Z✓ ���
7/25/97
Reviewer/Inspector Name
_ 71
Reviewer/laspector Signature:
Date: —��—p